Associations between cardiac arrhythmia, incident disability in activities of daily living and physical performance: the ILSA study

Background: Cardiac arrhythmias are common conditions in older people. Unfortunately, there is limited literature on associations between cardiac arrhythmias and physical performance or disability. We therefore aimed to prospectively investigate associations between cardiac arrhythmias and changes in disability and physical performance during 8 years of follow-up, using data from the Italian Longitudinal Study on Aging (ILSA). Methods: Cardiac arrhythmias diagnosis was posed through a screening phase, confirmed by a physician. The onset of disability in activities of daily living (ADL) and the changes in several physical performance tests during follow-up were considered as outcomes. Fully-adjusted and propensity-score Cox Proportional Hazard models and mixed models were used for exploring associations between cardiac arrhythmia and the outcomes of interest. Results: The prevalence of cardiac arrhythmia at baseline was 23.3%. People reporting cardiac arrhythmia at the baseline were significantly older, more frequently male, smokers and reported a higher presence of all medical conditions investigated (hypertension, heart failure, angina, myocardial infarction, diabetes, stroke), but no difference in dementia, Parkinsonism, cognitive or mood disorder. Cardiac arrhythmia at baseline was significantly associated with the incidence of disability in ADL (HR = 1.23; 95%: CI: 1.01–1.50; P = 0.0478 in propensity score analyses; HR = 1.28; 95% CI: 1.01–1.61; P = 0.0401 in fully adjusted models). Cardiac arrhythmia at baseline was also associated with a significant worsening in balance test (P = 0.0436). Conclusions: The presence of cardiac arrhythmia at baseline was associated with a significant higher risk of disability and of worsening in some physical performance tests, particularly those relating to balance. Screening and frequently assessing physical performance in older people affected by cardiac arrhythmia can be important to prevent a loss of physical performance, with further, potential, complications of medical management

Adverse Drug Reactions in Hospital In-Patients: A Prospective Analysis of 3695 Patient-Episodes

Adverse drug reactions (ADRs) are a major cause of hospital admissions, but recent data on the incidence and clinical characteristics of ADRs which occur following hospital admission, are lacking. Patients admitted to twelve wards over a six-month period in 2005 were assessed for ADRs throughout their admission. Suspected ADRs were recorded and analysed for causality, severity and avoidability and whether they increased the length of stay. Multivariable analysis was undertaken to identify the risk factors for ADRs. The 5% significance level was used when assessing factors for inclusion in multivariable models. Out of the 3695 patient episodes assessed for ADRs, 545 (14.7%, 95% CI 13.6–15.9%) experienced one or more ADRs. Half of ADRs were definitely or possibly avoidable. The patients experiencing ADRs were more likely to be older, female, taking a larger number of medicines, and had a longer length of stay than those without ADRs. However, the only significant predictor of ADRs, from the multivariable analysis of a representative sample of patients, was the number of medicines taken by the patient with each additional medication multiplying the hazard of an ADR episode by 1.14 (95% CI 1.09, 1.20). ADRs directly increased length of stay in 147 (26.8%) patients. The drugs most frequently associated with ADRs were diuretics, opioid analgesics, and anticoagulants. In conclusion, approximately one in seven hospital in-patients experience an ADR, which is a significant cause of morbidity, increasing the length of stay of patients by an average of 0.25 days/patient admission episode. The overall burden of ADRs on hospitals is high, and effective intervention strategies are urgently needed to reduce this burden

Effects of temperature on the crystal structure of epidote: a neutron single-crystal diffraction study at 293 and 1070K

The effects of temperature on the crystal structure of a natural epidote [Ca1.925 Fe0.745Al2.265Ti0.004Si3.037O12(OH), a = 8.890(6), b = 5.630(4), c = 10. 50(6) \uc5 and \u3b2 = 115.36(5)\ub0, Sp.Gr. P21/m] have been investigated by means of neutron single-crystal diffraction at 293 and 1,070 K. At room conditions, the structural refinement confirms the presence of Fe3+ at the M3 site [%Fe(M3) = 73.1(8)%] and all attempts to refine the amount of Fe at the M(1) site were unsuccessful. Only one independent proton site was located. Two possible hydrogen bonds, with O(2) and O(4) as acceptors [i.e. O(10)-H(1)\ub7\ub7\ub7O(2) and O(10)-H(1)\ub7\ub7\ub7O(4)], occur. However, the topological configuration of the bonds suggests that the O(10)-H(1)\ub7\ub7\ub7O(4) is energetically more favourable, as H(1)\ub7\ub7\ub7O(4) = 1.9731(28) \uc5, O(10)\ub7\ub7\ub7O(4) = 2.9318(22) \uc5 and O(10)-H(1)\ub7\ub7\ub7O4 = 166.7(2)\ub0, whereas H(1)\ub7\ub7\ub7O(2) = 2.5921(23) \uc5, O(10)\ub7\ub7\ub7O(2) = 2.8221(17)\uc5 and O(10)-H(1)\ub7\ub7\ub7O2 = 93.3(1)\ub0. The O(10)-H(1) bond distance corrected for "riding motion" is 0.9943 \uc5. The diffraction data at 1,070 K show that epidote is stable within the T-range investigated, and that its crystallinity is maintained. A positive thermal expansion is observed along all the three crystallographic axes. At 1,070 K the structural refinement again shows that Fe3+ share the M(3) site along with Al3+ [%Fe(M3)1,070K = 74(2)%]. The refined amount of Fe3+ at the M(1) is not significant [%Fe(M1)1,070K = 1(2)%]. The tetrahedral and octahedral bond distances and angles show a slight distortion of the polyhedra at high-T, but a significant increase of the bond distances compared to those at room temperature is observed, especially for bond distances corrected for "rigid body motions". The high-T conditions also affect the inter-polyhedral configurations: the bridging angle Si(2)-O(9)-Si(1) of the Si2O7 group increases significantly with T. The high-T structure refinement shows that no dehydration effect occurs at least within the T-range investigated. The configuration of the H-bonding is basically maintained with temperature. However, the hydrogen bond strength changes at 1,070 K, as the O(10)\ub7\ub7\ub7O(4) and H(1)\ub7\ub7\ub7O(4) distances are slightly longer than those at 293 K. The anisotropic displacement parameters of the proton site are significantly larger than those at room condition. Reasons for the thermal stability of epidote up to 1,070 K observed in this study, the absence of dehydration and/or non-convergent ordering of Al and Fe3+ between different octahedral sites and/or convergent ordering on M(3) are discussed

Cardiopulmonary resuscitation. Bicarbonate is of no value.

Letter to the Edito

Magnetite from the Cogne serpentinites (Piemonte ophiolite nappe, Italy) : insights into seafloor fluid-rock interaction

In the Cogne area (Aosta Valley, Western Italian Alps), magnetite mineralization occurs associated with different types of serpentinite (pseudomorphic, rodingitic and magnetite-rich serpentinites), which are also heterogeneous in terms of bulk chemical composition, mineral assemblage and mineral chemistry. The mineralization is hosted by a lizardite-, \ub1chrysotile-bearing serpentinite showing a pseudomorphic texture after oceanic peridotite. It contains fine-grained magnetite showing oscillatory zoning with Cr-poor cores ( 3c 0.4 wt.% Cr2O3), which are surrounded by Cr-rich inner euhedral rims (up to 17.0 wt.% Cr2O3), mantled in turn by partially resorbed Cr-bearing outer rims ( 3c2.0 wt.% Cr2O3). This dramatic variation of Cr content in magnetite is described by the exchange vector Fe3+Fe2+Cr3+-1 (Mn, Zn, Ni) 2+-1. The absence of Cr-rich spinel cores suggests that the source of chromium was the Cr-Tschermak component of the orthopyroxene, made available during the serpentinization-related breakdown. In these rocks, lizardite, the primary serpentine phase, is partially overgrown by prograde antigorite, indicating that serpentinization occurred under relatively low-T conditions in a preorogenic (i.e., oceanic) setting, and was followed by an Alpine metamorphic re-equilibration. Rodingitic serpentinite and serpentinite rich in magnetite are composed of, in highly variable amounts, diopside (locally with inclusions of partially disordered graphite), calcite, magnetite, andradite/hydroandradite, prograde olivine, brucite and serpentine (mostly antigorite but also relict lizardite), with minor chlorite and accessory apatite. Magnetite content can be very high. In these rocks, magnetite is exceptionally Cr-poor (almost Cr-free). Such almost Cr-free magnetite is characterized by significant Fe2+ \u8660 Mg substitution (2-15 mol.% MgFe2O4). Crystal-chemical investigations confirm that Mg, as in magnesioferrite, shows a strong preference for the octahedral site. Due to Fe2+ \u8660 Mg substitution, the Fe2+ content available for Fe2+ - Fe3+ electron hopping in the octahedral site decreases leaving Fe3+ in excess and giving rise to a charge increase. Additionally, a small Fe3+ - Fe2+ disorder is present at the tetrahedral site (Fe2+T = 0.07 apfu). The bulk-rock compositions and the mineral associations of rodingitic serpentinite and serpentinite rich in magnetite point to a strong metasomatism and iron mobilization sustained by CO2-bearing fluids, developed at the expense of the host serpentinite. These processes likely occurred on the Tethyian seafloor, mediated by fluids sourcing from hydrothermal vents. Thermodynamic modelling suggests that mineral assemblages observed in the Cogne area are consistent with a process of serpentinization coupled with Ca (\ub1Al) metasomatism at 300-360\ub0C. This might have been driven by carbon-saturated C-O-H fluids characterized by CO2 contents comparable to present-day seawater, capable of fixing the redox potential of rocks close to the fayalite-magnetite-quartz buffer. Nevertheless, magnetite and associated Fe-Ni sulphides suggest slight variations in fO2 (and fS2) conditions recorded, ranging from relatively reducing (magnetite-heazlewoodite-pentlandite \ub1 pyrrhotite) towards rather oxidizing (magnetite-millerite-pyrite) assemblages